|
ERCP STENT EXCHANGE W/DILATE
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 43276
|
| Hospital Charge Code |
76101761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$6,899.82 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem Medicaid |
$352.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,928.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,899.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,653.39
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Humana KY Medicaid |
$352.50
|
| Rate for Payer: Humana Medicare Advantage |
$4,928.44
|
| Rate for Payer: Kentucky WC Medicaid |
$356.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,914.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.75
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
ERCP STENT EXCHANGE W/DILATE
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 43276
|
| Hospital Charge Code |
76101761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.75
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
ERCP STENT EXCHANGE W/DILATE
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 43276
|
| Hospital Charge Code |
76101761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Anthem Medicaid |
$404.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Healthspan PPO |
$690.44
|
| Rate for Payer: Humana Medicaid |
$404.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$652.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$412.43
|
| Rate for Payer: Molina Healthcare Passport |
$404.34
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.38
|
|
|
ERCP STENT EXCHANGE W/DILAT(P
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 43276
|
| Hospital Charge Code |
761P1761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Anthem Medicaid |
$404.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$832.00
|
| Rate for Payer: Healthspan PPO |
$690.44
|
| Rate for Payer: Humana Medicaid |
$404.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$652.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$412.43
|
| Rate for Payer: Molina Healthcare Passport |
$404.34
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.38
|
|
|
ERCP W/SPECIMEN COLLECTION
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
76101751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.60 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.20
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
ERCP W/SPECIMEN COLLECTION
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
76101751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.76 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Anthem Medicaid |
$344.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,220.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$477.54
|
| Rate for Payer: Healthspan PPO |
$448.65
|
| Rate for Payer: Humana Medicaid |
$344.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$454.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.66
|
| Rate for Payer: Molina Healthcare Passport |
$344.76
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$854.00
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$348.21
|
|
|
ERCP W/SPECIMEN COLLECTION
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
76101751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.60 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem Medicaid |
$419.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Humana KY Medicaid |
$419.56
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Kentucky WC Medicaid |
$423.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.20
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
ERCP W/SPECIMEN COLLECTION(P
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
761P1751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.76 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Anthem Medicaid |
$344.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,220.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$477.54
|
| Rate for Payer: Healthspan PPO |
$448.65
|
| Rate for Payer: Humana Medicaid |
$344.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$454.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.66
|
| Rate for Payer: Molina Healthcare Passport |
$344.76
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$854.00
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$348.21
|
|
|
ERGONOVINE PROV TEST
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 93024
|
| Hospital Charge Code |
48000071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$482.37 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
ERGONOVINE PROV TEST
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 93024
|
| Hospital Charge Code |
48000071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
ER INP ROOM RATE
|
Facility
|
IP
|
$1,679.00
|
|
| Hospital Charge Code |
11000006
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$1,292.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,309.62
|
| Rate for Payer: Cash Price |
$839.50
|
| Rate for Payer: Cigna Commercial |
$1,393.57
|
| Rate for Payer: First Health Commercial |
$1,595.05
|
| Rate for Payer: Humana Commercial |
$1,427.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,376.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,477.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,259.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.49
|
| Rate for Payer: PHCS Commercial |
$1,611.84
|
| Rate for Payer: United Healthcare All Payer |
$1,477.52
|
|
|
ERY-TAB (ERYTHROMYC 250MG/1TAB
|
Facility
|
OP
|
$12.99
|
|
|
Service Code
|
NDC 52536018003
|
| Hospital Charge Code |
25000631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.13
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.78
|
| Rate for Payer: First Health Commercial |
$12.34
|
| Rate for Payer: Humana Commercial |
$11.04
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.43
|
| Rate for Payer: Ohio Health Group HMO |
$9.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.03
|
| Rate for Payer: PHCS Commercial |
$12.47
|
| Rate for Payer: United Healthcare All Payer |
$11.43
|
|
|
ERY-TAB (ERYTHROMYC 250MG/1TAB
|
Facility
|
IP
|
$12.99
|
|
|
Service Code
|
NDC 52536018003
|
| Hospital Charge Code |
25000631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.13
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.78
|
| Rate for Payer: First Health Commercial |
$12.34
|
| Rate for Payer: Humana Commercial |
$11.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.43
|
| Rate for Payer: Ohio Health Group HMO |
$9.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.03
|
| Rate for Payer: PHCS Commercial |
$12.47
|
| Rate for Payer: United Healthcare All Payer |
$11.43
|
|
|
ERYTHROMYCIN 2% GEL (60GM)
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
NDC 45802096696
|
| Hospital Charge Code |
25003049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Anthem Medicaid |
$1.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.99
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.86
|
| Rate for Payer: Humana Commercial |
$4.35
|
| Rate for Payer: Humana KY Medicaid |
$1.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.51
|
| Rate for Payer: Ohio Health Group HMO |
$3.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.59
|
| Rate for Payer: PHCS Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ERYTHROMYCIN 2% GEL (60GM)
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
NDC 45802096696
|
| Hospital Charge Code |
25003049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.99
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.86
|
| Rate for Payer: Humana Commercial |
$4.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.51
|
| Rate for Payer: Ohio Health Group HMO |
$3.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.59
|
| Rate for Payer: PHCS Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ERYTHROMYCIN 333 TA 333MG/1TAB
|
Facility
|
OP
|
$23.28
|
|
|
Service Code
|
NDC 52536018303
|
| Hospital Charge Code |
25000632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Anthem Medicaid |
$8.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.16
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: First Health Commercial |
$22.12
|
| Rate for Payer: Humana Commercial |
$19.79
|
| Rate for Payer: Humana KY Medicaid |
$8.01
|
| Rate for Payer: Kentucky WC Medicaid |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.49
|
| Rate for Payer: Ohio Health Group HMO |
$17.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.22
|
| Rate for Payer: PHCS Commercial |
$22.35
|
| Rate for Payer: United Healthcare All Payer |
$20.49
|
|
|
ERYTHROMYCIN 333 TA 333MG/1TAB
|
Facility
|
IP
|
$23.28
|
|
|
Service Code
|
NDC 52536018303
|
| Hospital Charge Code |
25000632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.16
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: First Health Commercial |
$22.12
|
| Rate for Payer: Humana Commercial |
$19.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.49
|
| Rate for Payer: Ohio Health Group HMO |
$17.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.22
|
| Rate for Payer: PHCS Commercial |
$22.35
|
| Rate for Payer: United Healthcare All Payer |
$20.49
|
|
|
ERYTHROMYCIN LACTOBIO 500MG VL
|
Facility
|
IP
|
$359.88
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
25002054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.78 |
| Max. Negotiated Rate |
$345.48 |
| Rate for Payer: Aetna Commercial |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.71
|
| Rate for Payer: Cash Price |
$179.94
|
| Rate for Payer: Cigna Commercial |
$298.70
|
| Rate for Payer: First Health Commercial |
$341.89
|
| Rate for Payer: Humana Commercial |
$305.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.69
|
| Rate for Payer: Ohio Health Group HMO |
$269.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.56
|
| Rate for Payer: PHCS Commercial |
$345.48
|
| Rate for Payer: United Healthcare All Payer |
$316.69
|
|
|
ERYTHROMYCIN LACTOBIO 500MG VL
|
Facility
|
OP
|
$359.88
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
25002054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.78 |
| Max. Negotiated Rate |
$345.48 |
| Rate for Payer: Aetna Commercial |
$277.11
|
| Rate for Payer: Anthem Medicaid |
$123.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$73.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$102.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.97
|
| Rate for Payer: Cash Price |
$179.94
|
| Rate for Payer: Cash Price |
$179.94
|
| Rate for Payer: Cigna Commercial |
$298.70
|
| Rate for Payer: First Health Commercial |
$341.89
|
| Rate for Payer: Humana Commercial |
$305.90
|
| Rate for Payer: Humana KY Medicaid |
$123.76
|
| Rate for Payer: Humana Medicare Advantage |
$73.31
|
| Rate for Payer: Kentucky WC Medicaid |
$125.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.69
|
| Rate for Payer: Ohio Health Group HMO |
$269.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.56
|
| Rate for Payer: PHCS Commercial |
$345.48
|
| Rate for Payer: United Healthcare All Payer |
$316.69
|
|
|
ERYTHROMYCIN OPHTH 1 GM
|
Facility
|
OP
|
$24.25
|
|
|
Service Code
|
NDC 574402450
|
| Hospital Charge Code |
25000633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Anthem Medicaid |
$8.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.92
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cigna Commercial |
$20.13
|
| Rate for Payer: First Health Commercial |
$23.04
|
| Rate for Payer: Humana Commercial |
$20.61
|
| Rate for Payer: Humana KY Medicaid |
$8.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.34
|
| Rate for Payer: Ohio Health Group HMO |
$18.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.52
|
| Rate for Payer: PHCS Commercial |
$23.28
|
| Rate for Payer: United Healthcare All Payer |
$21.34
|
|
|
ERYTHROMYCIN OPHTH 1 GM
|
Facility
|
IP
|
$24.25
|
|
|
Service Code
|
NDC 574402450
|
| Hospital Charge Code |
25000633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.92
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cigna Commercial |
$20.13
|
| Rate for Payer: First Health Commercial |
$23.04
|
| Rate for Payer: Humana Commercial |
$20.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.34
|
| Rate for Payer: Ohio Health Group HMO |
$18.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.52
|
| Rate for Payer: PHCS Commercial |
$23.28
|
| Rate for Payer: United Healthcare All Payer |
$21.34
|
|
|
ERYTHROMYCIN OPHTH OINT 3.5GM
|
Facility
|
OP
|
$3.01
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
25000634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Anthem Medicaid |
$1.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.35
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: First Health Commercial |
$2.86
|
| Rate for Payer: Humana Commercial |
$2.56
|
| Rate for Payer: Humana KY Medicaid |
$1.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.65
|
| Rate for Payer: Ohio Health Group HMO |
$2.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.93
|
| Rate for Payer: PHCS Commercial |
$2.89
|
| Rate for Payer: United Healthcare All Payer |
$2.65
|
| Rate for Payer: Aetna Commercial |
$2.32
|
|
|
ERYTHROMYCIN OPHTH OINT 3.5GM
|
Facility
|
IP
|
$3.01
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
25000634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.35
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: First Health Commercial |
$2.86
|
| Rate for Payer: Humana Commercial |
$2.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.65
|
| Rate for Payer: Ohio Health Group HMO |
$2.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.93
|
| Rate for Payer: PHCS Commercial |
$2.89
|
| Rate for Payer: United Healthcare All Payer |
$2.65
|
|
|
ESCHERCHIA COLL OPPA GENE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
ESCHERCHIA COLL OPPA GENE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
